AACN News—July 2004—People

Vol. 21, No. 2, JULY 2004

Emergency in the AirFor Patient, Nurse Was in the Right Place at the Right TimeBy Eric A. Nicolaus

Finally, after an hour-and-a-half drive and nearly six hours of plane delays, we were airborne and settling in for the remainder of our three-plus hour flight. Having worked up until we left for the airport, my wife Margie, a CCRN-certified critical care nurse, was trying to sleep.

“May I have your attention?” the announcing system boomed. “We have a medical emergency on board the aircraft. If there are any doctors or registered nurses on board, would you please come forward to the front of the aircraft?”

The voice of the flight attendant sounded urgent and unsettling.

“Margie,” I said to my now sleeping wife, “I think they need you up front. There’s a medical emergency.”

Without protest, Margie woke, got up and walked forward to the front of the aircraft. For the next three hours, I worried while I leaned out from my aisle seat to see her work with two strangers on a young woman lying on the floor and seemingly in acute distress.

During the flight, I saw IV fluids and injections prepared. What was really going on up there? How sick was this woman?

Just before landing, the flight attendant notified us that a “medical emergency” was in progress and that a sick passenger would be deplaned first.

Finally, Margie returned to explain what had taken place.

“A young lady had hyperglycemia. She had a glucose level of over 600 and her insulin pump broke,” she said.

Following is a brief account of what my wife, a pediatrician and a gynecologist did to stabilize and treat this patient under less than ideal conditions, on board a Boeing 767 flying at 38,000 feet.

Apparently, before the woman boarded the plane, her insulin injecting pump had broken. According to one of the other passengers, she had repeatedly vomited in the airport bathroom before boarding the plane.

An initial assessment by Margie and the pediatrician found the woman pale, ashen-colored, weak, nauseated, vomiting and in a near-fetal position.

In gathering the medical equipment onboard the aircraft, a very important tool was obtained—a glucose meter used in reading blood sugar levels. Margie tested the patient and found that the blood sugar level was “pegging” the meter at over 600 mg/dl, dangerously high. The physicians ordered 20 to 25 units of regular insulin to be administered from the patient’s pump syringe. Using the broken pump’s syringe and an 18-gauge needle, the only size available, Margie administered the insulin subcutaneously.

My wife commented that the syringe was hard to push, which meant she could easily have administered more or less than wanted. It was all a matter of approximation. Because the patient had lost fluids through vomiting and her diabetes, IV fluid was indicated.

Margie started an IV in the woman’s left antecubital. The only available bag was 500 cc normal saline, which she ran as fast as it could be delivered. The second bag of 500 cc normal saline followed, with the first 400 cc running at the same “wide open” rate. The last 100 cc was left to run slowly to keep the vein open for the remainder of the flight.

Margie, along with the pediatrician, regularly attended to the patient, checking blood glucose levels, heart rate and blood pressure, and keeping the patient comfortable as she continued to vomit coffee ground emesis.

When the woman’s blood glucose reading was still greater than 600 mg/dl an hour after the first dose, Margie administered a second dose of approximately 20 to 25 units of regular insulin. Neurological checks were regularly done to ensure the patient was lucid. An hour after the second insulin dose and 45 minutes before arriving at our destination, a recheck found a dramatic drop in the patient’s glucose level to 463 mg/dl had occurred. No additional insulin was administered.

While still in flight, the pediatrician wrote the progress report, treatment and vital signs, and Margie wrote her nursing notes. They turned over their notes and provided a briefing to the paramedics waiting on the ramp.

When I asked Margie about “lessons learned” from this experience, she replied: “The importance for nurses to maintain their clinical skills in caring for patients cannot be underestimated.”

I know Margie believes that this event verified just how valuable nursing skills are in saving lives and helping other people, regardless of where you are or what you’re doing. I know that Margie made a difference in someone’s life on an airplane flying at 38,000 feet.

Eric A. Nicolaus is a writer, editor and publisher of military firearms books. Margie C. Nicolaus is a PRN nurse supervisor at St. Mary’s Hospital, Athens, Ga. She is also a full-time ICU staff nurse and a BLS instructor. In addition, she fills a PRN position at the Athens Nurses Clinic, which serves the area’s indigent population. She has been CCRN certified since 1985.

Members on the Move

HonorsKyle Madigan, RN, BSN, CCRN, CEN, CFRN, received the Barbara A. Hess Award from the Association of Air Medical Services. The award recognizes individuals who have significantly contributed to the enhancement, development or promotion of the air medical industry through research or educational efforts. Madigan is a flight nurse-training and education coordinator with California Shock Trauma Air Rescue in Northern California.

Michael Williams, RN, MSN, CCRN, received the Outstanding Classroom Instruction Award from Eastern Michigan University, Ypsilanti. A past president of AACN, Williams is associate professor of nursing at the university.

ProfessionalJoe A. Flores, RN, MSN, CCRN, FNP, JD, opened two law offices in Texas, one in Corpus Christi and the other in Houston. An advanced practice and trial attorney for the past three years, Flores specializes in nursing home litigation, health law administration and general civil litigation.

Hatice Y. Foell, RN, MSN, ARNP-C, accepted a position as the adult nurse practitioner with the stroke program at Health First, Inc. Holmes Regional Medical Center Melbourne, Fla. She has been a critical care nurse and worked in various setting with critically ill patients for more than 20 years.